Examples of Computed Tomography Staging Systems

Stage

Description

Staging system proposed by Kennedy" 0

Normal

Anatomic abnormalities, all unilateral sinus disease, bilateral disease limited to ethmoidal sinuses

Bilateral ethmoidal disease with involvement of one dependent sinus Bilateral ethmoidal disease with involvement of two or more dependent sinuses on each side

Diffuse sinonasal polyposis

Staging system proposed by Gliklich and Metson (Harvard System)4

0 Normal (<2 cm mucosal thickening on any sinus wall)

1 All unilateral disease or anatomic abnormality

II Bilateral disease limited to ethmoidal or maxillary sinuses

III Bilateral disease with involvement of at least one sphenoidal or frontal sinus

IV Pansinus disease

Grading of sinus systems proposed by Lund and Mackay" Sinus system Left

Maxillary

Anterior ethmoidal Posterior ethmoidal Sphenoidal Frontal

Ostiomeatal complex Total points for each side:

Right

* Scoring: For all sinus systems, except the ostiomeatal complex: 0 = no abnormalities, 1 = partial opacification, 2 = total opacification. For the ostiomeatal complex: 0 = not occluded, 2 = occluded.

SOURCE:" Adapted from Kennedy DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 1992;102(suppl 57):1-18 SOURCE:''Adapted from Gliklich RE, Metson, R. A comparison of sinus computed tomography (CT) staging systems for outcomes research. Am J Rhi-nol 1994;8:291-297

SOURCE:" Adapted from Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology 1993;107:183-184

pared with other chronic illnesses. Such comparisons show that patients with chronic sinusitis have SF-36 scores in domains such as general health and vitality similar to scores of patients with other chronic illnesses, such as chronic obstructive pulmonary disease. Using generic health measures in this way gives us a better understanding of the relative public health impact of one illness versus another.

In order to obtain the measurement precision necessary to accomplish effective outcomes management systems, it is helpful to include condition-specific measures as part of the health status assessment. Although recommendations have been made in the literature over which particular instrument should be declared the "standard," there are significant hazards to this approach. Outcomes measures are classified according to purpose. Diagnostic tests are judged by their correlation with a clinical diagnosis. Prognostic measures predict a trait or a result. Discriminative indices classify patients as with or without the disease or characteristic. Evaluative measures track change over time. It is therefore the purpose of the study that determines which instrument is most suitable.12 One size does not fit all. In general, for therapeutic interventions such as surgery, evaluative measures are usually most appropriate.

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